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Flashcards in Echocardiology Deck (27):
1

Role of radiology (why it's necessary)

  • VHS enlarged
    • Normal?
    • Pericardial effusion?
    • True cardiomegaly?
      • Acquired or inherited cardiac disease?
      • Ethiology?
  • Diagnosis of concurrent thoracic disease
    • Dynamic airway disease
    • Cardiogenic pulmonary edema
  • Left atrial size can be better assessed

2

6 advantages of echocardiology?

  1. Non invasive real-time images of the beating heart
  2. Anatomic detail can be accurately visualized
  3. Cardiac measurements
    1. Assessment of size/function
  4. Grading of cardiac diseases
  5. Evaluate therapy success
  6. Interventional steps
    1. Pericardiocentesis under ultrasound guidance

3

What is the disadvantage of echocardiology?

A diagnosis of cardiac failure cannot be based on echocardiology alone

4

What transducer equipment is needed (size-specifics)?

  • Sector transducers
    • Large dogs = 3-5 MHz
    • Small dogs = 5-7.5 MHz
    • Cats = 7.5-10 MHz
  • Small acoustic coupling surface

5

Why use echo?

  • Echo and doppler have revolutionized cardiology
  • Prior to this technology: info had to be obtained through cardiac catheterization
  • Non-invasive technique
  • With experience it is possible to diagnose complex cardiovascular disease
  • Echo serves to clarify, quantify, and corroborate (and maybe even amend) your clinical impressions

6

What info can we collect from cardiac ultrasound (8)?

  • Chamber size
  • Wall thickness
  • Contractility
  • Cardiac motion
  • Cardiac function
  • Valvular lesions
  • Detection of masses
  • Cardiomegaly vs. pericardial effusion

7

Preparation for echocardiology?

  • Quiet patient is best
  • Sedation is avoided due to cardiovascular changes
  • Usually begin in right lateral recumbency on a specialty table
  • Gel or alcohol is applied liberally

8

3 modes of echo?

  1. M-mode
  2. B-mode
  3. Doppler
    1. Spectral
    2.  Color doppler

9

B-mode

Views?

Planes?

Anatomic info?

  • Real-time tomographic views of the heart
  • Longitudinal and transverse planes
  • Anatomic info
    • Masses
    • Valve abnormalities
    • Pericardial effusion
    • Septal defect
    • Global cardiac function and size (subjective)

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10

What mode does this represent?

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B-mode

11

M-mode echo

Scanned structures?

Used for?

Measures taken?

  • Only structures associated with the cursor will be scanned
    • Depth along y-axis
    • Time along x-axis
  • Use for measurements of:
    • Wall thickness
    • Chamber size
    • Fractional shortening
    • Valve movement pattern
  • 2-3 measurements should be taken

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12

What mode does this represent?

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M-mode

13

Doppler echo

Used for?

  • To determine normal and abnormal blood flow in the heart
  • Insufficiencies and stenosis
  • Acquired cardiac diseases
    • Make use of the doppler phenomenon
    • Doppler shift

14

What is the doppler principle?

The ANGLE is critical: blood flow must be parallel to the ultrasound beam

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15

Angle of incidence and velocity error

  • Maintain angle at <22o
    • Otherwise >10% error

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16

Spectral doppler echo

  • Velocity and direction along y-axis
  • Time along x-axis

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17

How are most doppler measurements obtained? What view is it?

  • Most are obtained from patient in LEFT lateral recumbency 
  • 4 CHAMBER--Apical view

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18

What is turbulent flow and what does it look like on the doppler echo?

What do the colors blue and red represent? 

What would mitral insufficiency look like?

What would aortic insufficiency look like?

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19

Standardized echocardiology

Where do you start?

Standard protocol?

 

  • Start from right hand side
    • 2D orientation and morphology
    • M-mode
      • Teicholz
    • Pulmonary valve flow dynamic (doppler)
  • Standard protocol
    • Right side:
      • 2 long axis views
      • 4 short axis views
    • Left side
      • At least 2 long axis views

20

Probe placement (at beginning)?

  • Right parasternal window
  • Long axis
  • Start from bottom-up:

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21

What view is this?

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Right parasternal long axis view

22

What are the various right parasternal short axis views?

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23

What view is this?

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Right parasternal short axis view

24

What view is this?

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Right parasternal short axis view

25

What is the M-mode used for?

  • Cardiac measurements
  • Fractional shortening

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26

Fractional shortening

EDD

ESD

Formula?

  • EDD = maximal diastolic left ventricular interior diameter
  • ESD = end systolic ventricular interior diameter
  • %FS = [(EDD - ESD) / EDD] x 100

27

Cardiac function: fractional shortening

  • Index for contractility
  • 28-45% in dogs
  • 44-55% in cats
  • Fast and informative